Cerebral Consequences of Cardiopulmonary Bypass

Smith, PeterL.C.; Newman, Stanton; Ell, P. J.; Treasure, Tom; Joseph, Philip; Schneidau, A.; Harrison, MichaelJ.G.

doi:10.1016/s0140-6736(86)90938-4

Cited by 269 publications

(79 citation statements)

References 10 publications

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“…17 A SD unit for each test is computed from all the preoperative scores. A deficit occurs in a test when the patient's postoperative score has dropped by Ն1 SD unit from the preoperative score.…”

Section: Discussionmentioning

confidence: 99%

“…These tests were chosen because our previous work had shown that they were sensitive to the effects of microembolism during cardiac surgery. 17 Measures of attention and concentration (Trail-Making A and B, Letter Cancellation, Two Choice Reaction Time, Symbol Digit, Displaced Reaction Time), verbal memory (Rey Auditory Verbal Learning Test), nonverbal memory (Nonverbal Memory Test), visuomotor skills (Finger Tapping, Grooved Pegboard) were administered both before and after the procedure. Assessments of mood state were also conducted before and after the intervention and at each testing session; the Beck Depression Inventory was used as an indication of depressed mood, and the Spielberger State Anxiety Inventory was employed to assess state anxiety (Table 1).…”

Section: Methodsmentioning

confidence: 99%

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Comparison of Microembolism Detected by Transcranial Doppler and Neuropsychological Sequelae of Carotid Surgery and Percutaneous Transluminal Angioplasty

Crawley

Stygall²,

Lunn³

et al. 2000

Stroke

181

152

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Background and Purpose-Percutaneous transluminal angioplasty (PTA) is currently being assessed for the treatment of carotid stenosis. In comparison with carotid endarterectomy (CEA), there is evidence of an increased risk of cerebral microembolism during the procedure. We have sought evidence of any neuropsychological sequelae of carotid PTA and compared it with CEA to demonstrate the relative safety of the 2 treatment options. Methods-The neuropsychological outcomes after CEA and PTA were compared in 2 matched groups of patients with severe symptomatic carotid stenosis, 96% of whom had been randomized in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS), at a single center. Transcranial Doppler insonation of the middle cerebral artery was used to measure cerebral reactivity in response to carbon dioxide inhalation before treatment and then to detect microembolization of the ipsilateral cerebral hemisphere and measure changes in blood flow velocity during the procedures. The performance on a neuropsychological test battery administered before, 6 weeks after, and 6 months after the procedure was compared in 20 patients undergoing PTA and 26 having CEA. Results-At 6 weeks, 5 patients in each group showed a similar decline in neuropsychological performance; global measures showed no significant difference between the 2 procedures, despite a significantly higher incidence of microemboli during PTA. Both groups showed a marked reduction in anxiety after treatment. Conclusions-The findings provide some reassurance that PTA is not associated with greater cerebral complications than CEA, despite the higher embolic load recorded by transcranial Doppler ultrasonography during angioplasty. (Stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Comparison of Microembolism Detected by Transcranial Doppler and Neuropsychological Sequelae of Carotid Surgery and Percutaneous Transluminal Angioplasty

Crawley

Stygall²,

Lunn³

et al. 2000

Stroke

181

152

View full text Add to dashboard Cite

show abstract

“…Potential perioperative events that may negatively interact with preoperative leukoaraiosislacunae volume include acute anemia (60)(61)(62)(63), hypotension (64), oxygen desaturation (65)(66)(67), and the production of emboli. In our sample, we acquired valid emboli data on 15 of our surgery participants.…”

Section: Considerations For Neuropsychological Measures and Potentialmentioning

confidence: 99%

A Pilot Study Evaluating Presurgery Neuroanatomical Biomarkers for Postoperative Cognitive Decline After Total Knee Arthroplasty in Older Adults

Price

Tanner

Schmalfuss

et al. 2014

Survey of Anesthesiology

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Background-Total knee arthroplasty improves quality of life but is associated with postoperative cognitive dysfunction in older adults. This prospective longitudinal pilot study with a parallel control group tested the hypotheses that: 1) nondemented adults would exhibit primary memory and executive difficulties after total knee arthroplasty, and 2) reduced preoperative hippocampus/entorhinal volume would predict postoperative memory change, whereas preoperative leukoaraiosis and lacunae volumes would predict postoperative executive dysfunction.

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“…~ At this time, clinically obvious stroke is found in five per cent and severe disability in one to two per cent of patients. 1.3 In a prospective study, Smith et al 2 demonstrated a significant increase in (signs of) CNS dysfunction at 24 hr after CPB, but no significant differences in the incidence of CNS dysfunction at eight days or eight weeks compared with controls undergoing major vascular or thoracic procedures. Cerebral blood flow (CBF), however, was only measured on the latter two occasions and was no different from controls.…”

mentioning

confidence: 98%

Autoregulation and the CO2 responsiveness of cerebral blood flow after cardiopulmonary bypass

et al. 1990

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Cerebral Consequences of Cardiopulmonary Bypass

Cited by 269 publications

References 10 publications

Comparison of Microembolism Detected by Transcranial Doppler and Neuropsychological Sequelae of Carotid Surgery and Percutaneous Transluminal Angioplasty

Comparison of Microembolism Detected by Transcranial Doppler and Neuropsychological Sequelae of Carotid Surgery and Percutaneous Transluminal Angioplasty

A Pilot Study Evaluating Presurgery Neuroanatomical Biomarkers for Postoperative Cognitive Decline After Total Knee Arthroplasty in Older Adults

Autoregulation and the CO2 responsiveness of cerebral blood flow after cardiopulmonary bypass

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